Itraconazole
- PDF / 152,489 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 43 Downloads / 145 Views
1 S
Stevens Johnson syndrome and toxic epidermal necrolysis: case report A 16-year-old girl developed Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN) during treatment with itraconazole for onychomycosis. The girl presented with a 3-day history of fever and reddish rashes over her upper limbs, face, chest and back (current presentation at the hospital in India). It was reported that she had consulted with a paediatrician for finger-nail onychomycosis, who had prescribed her oral itraconazole 400mg daily for 7 days a month, to be continued for 3–4 cycles. On the next day, on day 1, she started receiving itraconazole by herself. On day 3, her parents noticed the development of red lesions on her face and back, fever and myalgia. At the current presentation, on day 5, cutaneous examination showed numerous erythematous to purpuric macules coalescing to form patches, distributed over upper limbs, face, abdomen chest and back amounting to approximately 25% body surface area involvement. Pseudo-Nikolsky’s sign was found to be positive on the back. Erosions were noted over genital and oral mucosae. The conjunctival redness with the mild mucopurulent discharge were observed on ocular examination. Her medicine record showed that she did not receive any medications other than itraconazole. The girl’s itraconazole treatment was discontinued. Thereafter, she was immediately admitted to the in-patient department with a diagnosis of SJS-TEN overlap. Routine laboratory investigations revealed an elevation in CRP, serum glucose and transaminase. Screening for antinuclear antibodies and mycoplasma were found to be negative. A punch biopsy was performed from a lesion on the back which demonstrated blister formation at the dermo-epidermal junction with extensive dyskeratosis of the epidermis. The presence of extensive keratinocyte necrosis with the paucity of inflammation confirmed the diagnosis of SJS-TEN overlap. Under symptomatic management, she was started on off-label treatment with ciclosporin 4 mg/kg daily for 10 days with a good response. Eventually, an improvement in cutaneous lesions was noted with post-inflammatory hyperpigmentation, and the progression of lesions stopped. On day 11 of admission, she was discharged home. The SCORe of Toxic Epidermal Necrosis (SCORTEN) was noted as 2 and mortality risk was estimated to be 12.1%. The causal relationship between itraconazole and SJS/TEN was found to be probable according to the causality assessment by the Naranjo probability scale (Naranjo score of 6), and probable/likely as per the World Health Organization-Uppsala Monitoring Centre criteria. The algorithm of drug causality for epidermal necrolysis (ALDEN) score was +3 and the reaction was labeled as possible. As per the modified Hartwig and Siegel ADR severity assessment scale, her reaction was graded as level 3 (moderate). Das A, et al. Itraconazole induced Steven-Johnson syndrome and toxic epidermal necrolysis overlap: report of a rare incident. Dermatologic Therapy : 1-2, 22 Sep 2020. 803508279 Available
Data Loading...
